Subcutaneous and sublingual immunotherapy versus conventional therapy in atopic dermatitis

ABSTRACT

Subcutaneous immunotherapy [SCIT] has been shown to improve eczema in patients with atopic dermatitis [AD]. Recently, a sublingual route with a more satisfactory safety profile has emerged, as an effective alternative to SCIT. To date, there are only a few studies regarding the efficacy and safety of sublingual immunotherapy [SLIT] in patients with AD. The aim of the study was to compare the clinical efficacy of SCIT and SLIT in patients with AD, as compared to conventional therapy. In addition, the efficacy of SLIT using food allergens was assessed. This study was conducted on 60 AD patients with a positive skin prick test [SPT] reaction to inhalant allergens. Immunotherapy using inhalant allergens was given subcutaneously in 20 patients [group A], and sublingually in 20 patients [group B]. In group B, patients who also showed a positive SPT reaction to a food allergen received additional SLIT using that food allergen. 20 patients received conventional therapy only for AD [group C]. All groups received therapy for six months. We assessed the following outcomes: severity of atopic dermatitis by SCOR.AD, SPT reactivity, and total serum IgE levels at baseline, and after 6 months of therapy. After 6 months, the mean SCORAD decreased significantly in all 3 groups. Both immunotherapy groups showed a comparable percent of change in SCORAD, which was significantly higher than in group C. A marked reduction in the use of topical corticosteroids and oral antthistamines was detected among groups A and B. A negativization of skin tests, as well as a decreased reactivity to inhalant allergens occurred almost only among groups A and B. 58% of patients in group B, who were given SLIT for food allergens showed a negativization or a decreased reactivity of SPT reactions to food allergens. A substantially higher proportion of patients receiving SCIT reported side effects as compared to those receiving SLIT, Total serum IgE levels did not change significantly among any of the 3 groups. Both SCIT and SLIT are effective in AD, but the ease of administration and the lower incidence of side effects with SLIT encourage its use. SLIT with food allergens was effective in a substantial proportion of patients, and its clinical usefulness deserves additional studies